I stepped into the waiting room and called out his birthdate. At Whitman-Walker, that's how we call people for their test results. No names, no identification. His birthdate was in 1963, making him 24, not much older than my own son.
He nervously sat down, then looked up at me expectantly and hopefully. I introduced myself, verified his birthdate and prepared to tell him that he is infected with the AIDS virus.
Why didn't my years as a psychologist and a professional sex counselor make this new role any easier?
At moments like this, I can't help but feel like an executioner. How can I delay or soften the "bad news"? I wanted to stall, make frivolous comments about his beautiful shirt or the squeaky roller on the chair. Anything to postpone the ultimate message.
He had not lived long enough to be so unlucky in life.
As I gathered my courage to tell him that his test had come back positive, he covered his head and began sobbing like a child, checking himself, trying to stop his outburst. I could only encourage him to let his feelings out as I felt my own tears of helplessness. Finally, he looked up with terror in his swollen eyes and just stared at me, numb from his fear and anger.
In trying to explain the meaning of the results, I fully knew he heard nothing I was saying. I felt like a mechanical robot going through the process of describing the implications of the ELISA test for HIV infection. Where were my feelings? I was as numb as the patient to the words I was mouthing.
What did he really want to talk about at that moment? How could I be supportive and help him assimilate and absorb the information I was giving him? Most important, what could I do to try to ease his mind? Is it even possible?
Sitting quietly with him was excruciating for me. He would regain his composure momentarily, only to become again like a spooked animal and pull into himself, isolating me from his feelings. I knew he had removed himself from the situation and the information.
I couldn't get through. I was stung with the helplessness of not knowing how to take the pain away. And I was again engulfed with the fear he was facing -- the 20 to 30 percent chance he would become ill and die within five years, and an increasing chance after that, wondering where he would get the comfort and medical support he would need.
Looking down my list of patients that evening, I noticed another positive result just beneath my client's, and I asked if his lover were there and had been tested.
He broke down again, saying he was too ashamed to ever face him again, believing he might have been the one to transmit the virus. But who really knows? It could have been passed in the other direction. Or the exposure to AIDS could have taken place as much as five to seven years earlier.
Suddenly, there was a knock at the door as another counselor advised me she had been talking with my client's lover, who wanted to meet with him. While my client resisted at first, he consented to see his lover in the next room after we had talked over some of his concerns.
I could feel his initial embarrassment as he walked into the room. We left them to comfort one another in private. Meanwhile, we busied ourselves collecting referral material, drinking coffee and avoiding our own feelings of impotence and helplessness.
As I left this young couple together to share their shock and sorrow, I worried how they would be able to handle the stress. My client had been tongue-tied just trying to talk about simple sexual matters with me. He already had acknowledged he felt inadequate discussing such personal matters candidly with his lover.
Not only did they have to confront their own feelings about safer sex practices, but also such topics as betrayal, fear of abandonment and the death they might be facing. ::
The Whitman-Walker clinic, founded in 1973 as a gay health center, is the city's main AIDS testing site. It guarantees anonymity and confidentiality. Testing is done by appointment every Wednesday, and results are given in person two days later. For two years, I have been one of about eight volunteers and staff who tell people their results and counsel them.
In a typical week, about 100 people are tested and fewer than 15 percent are positive. Currently, almost half of the people coming for testing are heterosexual.
Each person responds differently to hearing that he or she is infected with the AIDS virus. Some clients, already suspecting they are infected, are better prepared and more composed when they hear the bad news, actually sounding upbeat and hopeful. Too often, there is an air of unreality, quite unnerving to me, and I am left wondering what they are actually feeling.
And much goes unsaid in these sessions. I am always asking myself, what are the appropriate limitations of my role? No client has ever told me directly that he or she would refuse to warn their partners, or that they would refuse to practice safe sex, but many times I am unconvinced about their sincerity to do so.
However, I am in no position and have no right to follow them around and monitor their behavior. Once I've said my piece, I am rendered helpless. They leave the clinic, and I probably will never see them again.
But controlling my own feelings is not easy. After counseling someone who is so angry at the diagnosis that he doesn't care about whom he infects, I feel revolted and terrified. But what can I do? Actually, nothing, except to resolve to try harder next time, to listen more closely to people's resistance about being responsible and to try to find some way to reach them.
Such cases are rare. And I have to remind myself that if we didn't guarantee the anonymity of testing, then we probably wouldn't get to educate these people at all. This counseling session may be my one shot at making a difference.
But my role has clear limitations. I am there to give information and to counsel and advise. After this, any decision about a client's life and life style is a purely personal one. Where is the place for personal judgments?
Nai ve? Perhaps. But being hopeful is the only way I've found to continue this work. Unless I believe that people want to live and don't want to hurt others, I couldn't function as a psychologist.
In my training, I was taught to "act appropriately," to guard against over-involvement and over-identification, to suppress my personal feelings. Even though sometimes I might become annoyed when one of my clients forces me to grieve with him, I cannot believe that's unprofessional; it's just being human.
It is also difficult to feel comfortable with a client who, angry at his or her fate, accuses me of being responsible for it. When one young man verbally attacked me for giving him false hope and for not being able to genuinely understand, it was very hard for me to feel sympathy. I clearly had failed at helping him accept his diagnosis, and he was very effective at reminding me of my limitations.
When a test result is negative -- no infection -- I have to switch gears. Many anxious clients, the "worried well," are not ill but insist they must be or will be eventually. They need a tremendous amount of reassurance. At the same time I must reinforce in their minds the importance of limiting the number of their number of sexual partners and using condoms.
Many heterosexual men and women also become obsessed about getting AIDS for no particular rational reason. Even given the known facts about the disease and how it is contracted, even knowing that they are AIDS-free, they still are not consoled. These obsessive worriers often are more taxing to the counselor than those who become angry at the "bad news" messenger. ::
To guard against emotional exhaustion and burnout, the Whitman-Walker staff gathers together in its own support group after the clients leave. That is when we can palpably express the collective anger and discomfort we all feel after absorbing our clients' anxiety. We, too, need a safe place to unwind and express our frustrations.
Martha Winter Gross, Phd, is a licensed psychologist and sex therapist practicing in Washington. People interested in taking the AIDS antibody test may call 332-EXAM. Whitman-Walker will also refer people to other confidential testing sites in the area.